{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3463.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3463.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3463.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3463.html"}],"law_id":83601,"edition_id":1,"section_id":83601,"structure_id":16548,"section_number":"38.2-3463","catch_line":"Health care price transparency tools","history":"2019, cc. 666, 684.","full_text":"Beginning with health benefit plans offered or renewed on or after July 1, 2020, each health carrier offering a health benefit plan in the Commonwealth shall comply with the following requirements:\n\n1\n\nA health carrier shall establish an interactive mechanism on its website that enables a covered person to request and obtain from the health carrier the estimated out-of-pocket cost to the covered person for comparable health care services from network providers, as well as quality data for those providers, to the extent available. The interactive mechanism shall allow a covered person seeking information about the cost of a comparable health care service to compare estimated out-of-pocket costs applicable to that covered person’s health benefit plan. The out-of-pocket estimate shall provide a good faith estimate of the amount the covered person will be responsible to pay out-of-pocket for a proposed comparable health care service or service that is a medically necessary covered benefit from a health carrier’s network provider, including any copayment, deductible, coinsurance, or other out-of-pocket amount for any covered benefit, based on the information available to the health carrier at the time the request is made. A health carrier may contract with a third-party vendor to satisfy the requirements of this subdivision.2\n\nNothing in this section shall prohibit a health carrier from imposing cost-sharing requirements disclosed in the covered person’s covered benefit plan for unforeseen health care services that arise out of the comparable health care service or for a procedure or service provided to a covered person that was not included in an original estimate provided under subdivision 1.3\n\nA health carrier shall notify a covered person that an estimate provided under subdivision 1 is an estimate of costs and that the actual amount the covered person will be responsible to pay may vary due to the need for unforeseen services that arise out of the proposed comparable health care service.","order_by":null,"text":{"0":{"id":299582,"text":"Beginning with health benefit plans offered or renewed on or after July 1, 2020, each health carrier offering a health benefit plan in the Commonwealth shall comply with the following requirements:","type":"section","prefixes":[""],"prefix":"","entire_prefix":"","prefix_anchor":"","level":1,"next_prefix":"1"},"1":{"id":299583,"text":"A health carrier shall establish an interactive mechanism on its website that enables a covered person to request and obtain from the health carrier the estimated out-of-pocket cost to the covered person for comparable health care services from network providers, as well as quality data for those providers, to the extent available. The interactive mechanism shall allow a covered person seeking information about the cost of a comparable health care service to compare estimated out-of-pocket costs applicable to that covered person’s health benefit plan. The out-of-pocket estimate shall provide a good faith estimate of the amount the covered person will be responsible to pay out-of-pocket for a proposed comparable health care service or service that is a medically necessary covered benefit from a health carrier’s network provider, including any copayment, deductible, coinsurance, or other out-of-pocket amount for any covered benefit, based on the information available to the health carrier at the time the request is made. A health carrier may contract with a third-party vendor to satisfy the requirements of this subdivision.","type":"section","prefixes":["1"],"prefix":"1","entire_prefix":"1","prefix_anchor":"1","level":1,"prior_prefix":"","next_prefix":"2"},"2":{"id":299584,"text":"Nothing in this section shall prohibit a health carrier from imposing cost-sharing requirements disclosed in the covered person’s covered benefit plan for unforeseen health care services that arise out of the comparable health care service or for a procedure or service provided to a covered person that was not included in an original estimate provided under subdivision 1.","type":"section","prefixes":["2"],"prefix":"2","entire_prefix":"2","prefix_anchor":"2","level":1,"prior_prefix":"1","next_prefix":"3"},"3":{"id":299585,"text":"A health carrier shall notify a covered person that an estimate provided under subdivision 1 is an estimate of costs and that the actual amount the covered person will be responsible to pay may vary due to the need for unforeseen services that arise out of the proposed comparable health care service.","type":"section","prefixes":["3"],"prefix":"3","entire_prefix":"3","prefix_anchor":"3","level":1,"prior_prefix":"2"}},"ancestry":[{"id":16548,"edition_id":1,"name":"Health Care Shared Savings","identifier":"8","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 04:23:38","date_modified":"2026-06-26 04:23:38","permalink":{"id":215597,"object_type":"structure","relational_id":16548,"identifier":"8","token":"38.2\/34\/8","url":"\/38.2\/34\/8\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":83999,"structure_id":16548,"section_number":"38.2-3461","catch_line":"Definitions","url":"\/38.2-3461\/","token":"38.2\/34\/8\/38.2-3461","metadata":false},{"id":86724,"structure_id":16548,"section_number":"38.2-3462","catch_line":"Comparable Health Care Service Incentive Program","url":"\/38.2-3462\/","token":"38.2\/34\/8\/38.2-3462","metadata":false},{"id":83601,"structure_id":16548,"section_number":"38.2-3463","catch_line":"Health care price transparency tools","url":"\/38.2-3463\/","token":"38.2\/34\/8\/38.2-3463","metadata":false},{"id":70954,"structure_id":16548,"section_number":"38.2-3464","catch_line":"Rules and regulations; orders","url":"\/38.2-3464\/","token":"38.2\/34\/8\/38.2-3464","metadata":false}],"previous_section":{"id":86724,"structure_id":16548,"section_number":"38.2-3462","catch_line":"Comparable Health Care Service Incentive Program","url":"\/38.2-3462\/","token":"38.2\/34\/8\/38.2-3462","metadata":false},"next_section":{"id":70954,"structure_id":16548,"section_number":"38.2-3464","catch_line":"Rules and regulations; orders","url":"\/38.2-3464\/","token":"38.2\/34\/8\/38.2-3464","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3463\/","history_text":"

This law was first created in 2019. The record of its establishment is cataloged in chapters 666<\/a> and 684<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year.<\/p>","references":[{"id":56508,"section_number":"54.1-2910.01","catch_line":"Practitioner information provided to patients","order_by":null,"url":"\/54.1-2910.01\/"}],"refers_to":false,"permalink":{"id":215607,"object_type":"law","relational_id":83601,"identifier":"38.2-3463","token":"38.2\/34\/8\/38.2-3463","url":"\/38.2-3463\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3463\/","token":"38.2\/34\/8\/38.2-3463","dublin_core":{"Title":"Health care price transparency tools","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3463","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

Beginning with health benefit plans<\/span> offered or renewed on or after July 1, 2020, each health carrier<\/span> offering a health benefit plan<\/span> in the Commonwealth shall comply with the following requirements:<\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> A health carrier<\/span> shall establish an interactive mechanism on its website that enables a covered person<\/span> to request and obtain from the health carrier<\/span> the estimated out-of-pocket cost to the covered person<\/span> for comparable health care services<\/span><\/span> from network providers<\/span>, as well as quality data for those providers, to the extent available. The interactive mechanism shall allow a covered person<\/span> seeking information about the cost of a comparable health care service<\/span><\/span> to compare estimated out-of-pocket costs<\/span> applicable to that covered person<\/span>’s health benefit plan<\/span>. The out-of-pocket estimate shall provide a good faith estimate of the amount the covered person<\/span> will be responsible to pay out-of-pocket for a proposed comparable health care service<\/span><\/span> or service that is a medically necessary covered benefit from a health carrier<\/span>’s network provider<\/span>, including any copayment, deductible, coinsurance, or other out-of-pocket amount for any covered benefit, based on the information available to the health carrier<\/span> at the time the request is made. A health carrier<\/span> may contract<\/span> with a third-party<\/span> vendor to satisfy the requirements of this subdivision. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Nothing in this section shall prohibit a health carrier<\/span> from imposing cost-sharing requirements disclosed in the covered person<\/span>’s covered benefit plan for unforeseen health care services<\/span> that arise out of the comparable health care service<\/span><\/span> or for a procedure or service provided to a covered person<\/span> that was not included in an original estimate provided under subdivision 1. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> A health carrier<\/span> shall notify a covered person<\/span> that an estimate provided under subdivision 1 is an estimate of costs and that the actual amount the covered person<\/span> will be responsible to pay may vary due to the need for unforeseen services that arise out of the proposed comparable health care service<\/span><\/span>. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nHEALTH CARE PRICE TRANSPARENCY TOOLS (\u00a7 38.2-3463)\n\nBeginning with health benefit plans offered or renewed on or after July 1, 2020,\neach health carrier offering a health benefit plan in the Commonwealth shall\ncomply with the following requirements:\n\n1. A health carrier shall establish an interactive mechanism on its website that\nenables a covered person to request and obtain from the health carrier the\nestimated out-of-pocket cost to the covered person for comparable health care\nservices from network providers, as well as quality data for those providers, to\nthe extent available. The interactive mechanism shall allow a covered person\nseeking information about the cost of a comparable health care service to\ncompare estimated out-of-pocket costs applicable to that covered person’s\nhealth benefit plan. The out-of-pocket estimate shall provide a good faith\nestimate of the amount the covered person will be responsible to pay\nout-of-pocket for a proposed comparable health care service or service that is a\nmedically necessary covered benefit from a health carrier’s network\nprovider, including any copayment, deductible, coinsurance, or other\nout-of-pocket amount for any covered benefit, based on the information available\nto the health carrier at the time the request is made. A health carrier may\ncontract with a third-party vendor to satisfy the requirements of this\nsubdivision.\n\n2. Nothing in this section shall prohibit a health carrier from imposing\ncost-sharing requirements disclosed in the covered person’s covered\nbenefit plan for unforeseen health care services that arise out of the\ncomparable health care service or for a procedure or service provided to a\ncovered person that was not included in an original estimate provided under\nsubdivision 1.\n\n3. A health carrier shall notify a covered person that an estimate provided\nunder subdivision 1 is an estimate of costs and that the actual amount the\ncovered person will be responsible to pay may vary due to the need for\nunforeseen services that arise out of the proposed comparable health care\nservice.\n\nHISTORY: 2019, cc. 666, 684.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}